Staff Reimbursement Form

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How to create a Staff Reimbursement Form? What is an example of reimbursement form? Download this Staff Reimbursement Form template now!

This staff expense reimbursement form is used to allow employees to submit their claims for reimbursement for any kind of business expenses, that will be paid by the company, while conducting business on behalf of an organization, and for petty cash replenishments. Often such expenses were paid by the employee him or herself. The responsibility for completing an accurate, compliant, and properly authorized reimbursement claims rests solely by the employee/person that prepares the form, or the account holder. Since every day brings new projects, emails, documents, and task lists, and often they go hand in hand with expenses, it's very common to work with a standard reimbursement form in your organization that everybody can fill in and file at Accounts or Finance department. 

This form is to claim reimbursement for business expenses paid while conducting business on behalf of the university and for petty cash replenishments. Responsibility for complete, accurate, compliant, and properly authorized claims rests with account holders and preparers.

STAFF REIMBURSEMENT FORM PAYABLE TO (FULL NAME): EMPLOYEE : SCHOOL : DEPT./ PURPOSE: SUPPLIER DATE: RECEIPT DATE ACCOUNT NO..

Expense Allocation (please group expenses by coding) 
  • FundTotal reimbursement and total allocated must be equal 
  • Who to contact about this claim: Contact Name Phone Email Dept Total Allocated (B) 0.00 (A)-(B) must equal 
  • Is currency conversion required If "yes" specify: 
  • Currencies other than CAD/USD will be paid by wire, attach International Payment Information Form Claimant s One over One Approver Signature Approver s 
  • Claimant s Signature (or attach declaration) 
  • Date (dd-mmm-yy) 
  • Account Holders Signature (Delegate) 
  • Printed Name 
  • Title
  •  I attest that the expenses claimed are original and I certify that I have reviewed this claim and find it to be reasonable I authorize these expenses to be charged to the legitimate incurred on authorized business and have an account(s) noted and that sufficient budget exists.
Example of reimbursement are: It's basically money paid to an employee, customer, or another party as a repayment for a business expense they have paid out of their own pocket. Expenses noted on the form may include business expenses, insurance costs and overpaid taxes (although reimbursement is not subject to taxation), office supplies, travel, accommodations, etc. 

This Staff Reimbursement Form has ways to grab your reader’s attention. It is drafted by HR professionals, intelligently structured and easy-to-navigate through. Pay close attention to the most downloaded HR templates that fit your needs.     

Using this form guarantees you will save time, cost, and effort! It comes in Microsoft Office format, is ready to be tailored to your personal needs. An easy way to start completing your request for reimbursement form is to download this Staff Claim Form template now! 


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